| A Conceptual Outline
Mindfulness-integrated Cognitive Behaviour Therapy or MiCBT is a sophisticated integration of skills developed with mindfulness training and cognitive behaviour therapy principles (CBT). The Mindfulness-CBT integration represents authors and clinicians’ effort from multidisciplinary backgrounds whose dedication to scientific inquiry, creativity, and openness has contributed to the current paradigm shift in psychotherapy.
Traditional cognitive therapy models attempt to alter maladaptive behaviour by modifying its concomitant dysfunctional thoughts and underlying assumptions. However, empirical evidence suggests that our attempt to change aversive internal experiences actively (e.g., thoughts, emotions and body sensations) often multiplies our problems (e.g. in PTSD, GAD, pain, etc.). Consistent with Einstein’s opinion that “we cannot change a problem with the means that created it”, mindfulness and acceptance-based approaches take the view that attempting to change the content of incapacitating thoughts is less productive in the long term than learning to develop control over the processes that maintain them.
Mindfulness and Attention
To achieve such control, mindfulness meditation training involves paying attention to each event experienced in the present moment within the framework of one’s body and mind, with a non-judgmental, non-reactive and accepting attitude. It may be broadly operationalised as a “generalised metacognitive and interoceptive exposure and response prevention” technique.
Trainees begin with a set of breath concentration exercises to develop meta-cognitive awareness and minimise distractibility. This alone enables a more objective appraisal of what thoughts are, just “thoughts” rather than “truths” about themselves and the world. Trainees learn that thoughts are merely ideas and memories impermanent and insubstantial and learn not to identify with them; they learn to gently and patiently let them go as they emerge in consciousness.
Then trainees are taught how to scan their body systematically and develop an ability to feel both salient and more subtle sensations while purposefully inhibiting learned (automatic) responses. This entails systematic desensitisation to whatever internal experience is encountered on the way.
Taken together, developing these skills involves the training of attentional functions, which may engage the vigilance network (dorsolateral region of the prefrontal cortex and its reciprocal connections to a centralised area of the striatum) and the executive control network (orbital-frontal regions of the left prefrontal cortex and its reciprocal interconnections with the ventromedial region of the striatum).
The Co-emergence Model of Reinforcement
Cayoun’s (2004, 2011) model of Mindfulness-integrated Cognitive Behaviour Therapy (MiCBT) is a sophisticated integration of mindfulness core principles and traditional CBT, which rests on a neuro-phenomenological model of reinforcement, the Co-emergence Model of Reinforcement. This approach involves a detailed account of micro-level reinforcement and extinction principles, as they are actually experienced. It suggests that once a trigger is perceived via sensory pathways, its judgmental interpretation at higher cortical levels leads unavoidably to some co-emerging body sensations, towards which one automatically (“mindlessly”) reacts to decrease aversive experiences or increase pleasant ones.
Thus, reinforcement is regarded as being dependent upon learned reactions toward intrinsically coupled cognitions and body sensations. This formulation is a major contribution to the science of Learning Theory, as it proposes that all forms of conditioning in humans require operant conditioning to function.
Cayoun and colleagues’ series of case studies and group outcome data demonstrate that preventing such reactions while remaining fully aware and accepting bodily experiences leads to the rapid extinction of conditioned responses, whatever is the disorder’s nature. Cognitive reappraisal emerges naturally from this freeing experience. “Self-worth”, or rather, satisfaction with life, springs from a deep sense of achievement, sense of self-control and self-efficacy.
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